Care Plan- Dehydration- Nursing

Topics: Salivary gland, Stomach, Teeth Pages: 9 (2195 words) Published: May 17, 2011
A 5 year old girl Jenny has presented to the Emergency Department with her mother, she is suffering from a variety of symptoms including wheezing and vomiting, a dry mouth, and a temperature of 39.7 degrees Celsius. Vomiting is when the person is excreting all food from there stomach via the mouth using forces from the oesophagus and stomach (Hockenberry & Wilson, 2007). The rationale for choosing this symptom is that vomiting is a clear sign that the body is trying to get rid of a pathogen, with a large amount of vomiting the body is losing valuable nutrition and electrolytes, and will fail to function properly (Britt, 2007). If left untreated vomiting can cause children to lose a lot of fluids and become dehydrated (Van Rensburg, 2009). Dry mouth is known as Xerostomia it is a common problem, and is usually caused by systematic disease and decreased salivary flow, Dry mouth can be a sign of Dehydration (Turner & Ship, 2007). The rational for choosing dry mouth is important as it represents fluid depletion in the body, without this fluid the cells cannot function properly; it needs to be treated, to ensure fluid levels are raised.

A temperature of 39.7 is the body’s internal area rising, due to the body trying to fight of an infection. The rational for choosing this symptom is that the temperature needs to be back in normal ranges for the body to carry out normal functions, a temperature of 39.7 puts the body in shock and can cause things such as fainting, low blood pressure and even seizures (Hockenberry & Wilson, 2008). The Pathophysiology of Vomiting is induced by the stomach muscles pushing bolos of food from the stomach to the oesophagus. When the stomach becomes full with gastric material, the muscles of the abdomen and the diaphragm contract (Hockenberry & Wilson, 2008). The oesophageal sphincter then opens and all the contents are removed from the mouth. An area in the brain called the postrema which is found in the fourth ventricle is thought to stimulate chemoreceptors which induce vomiting (Van Rensburg, 2009). The Vagus cranial nerve becomes active when the pharynx is disturbed, this causes a gag reflex; this can then lead to the stomach wanting to remove all of its contents, or can occur after a vomiting episode. The Sympathetic nervous system is also used when vomiting occurs as the body naturally begins to sweat and heart rate will rise (McCance, Huether, Brashers, & Rote, 2010). Salivary glands will work overtime to produce more saliva to help protect the enamel on teeth. Retching can occur when a person is vomiting. When the intrathoracic muscles contract rapidly without notice, the food is trying to escape is pushed up, if the glottis is not completely closed this will push the air through and cause a disturbing sound which is known as retching(McCance, Huether, Brashers, & Rote, 2010). This sound alone can trigger vomiting as it helps the body to build up enough pressure to be able to remove all the contents of the stomach in one go.

The pathophysiolgy of Dry mouth occurs when the submandibular and sublingual salivary glands stop producing enough salvia within the mouth, a variety of medications can cause this too occur, along with Sjoren's Syndrome and old age (Turner & Ship, 2007). When a dry mouth occurs the mucosa is stimulated and this signals the salivary responses in the medulla. The efferent nerve releases acetylcholine in the salivary gland terminals which trigger the release and flow of saliva (Turner & Ship, 2007). If left untreated dry mouth can cause a lot of problems with tooth decay as the teeth have no protection from food and debris (Strube, 1994).

The pathophisolgy of a high temperature or fever in a child is a problem in itself, it shows that the body is under a lot of pressure to fight of a pathogen (Cohee, Crocetti, Serwin, Sabath & Kapoor, 2010), the body can have various amounts of temperatures changes throughout a day, this is controlled by the thermoregulatory centre...
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